Clinical predictors of azole resistance, outcome and survival from oesophageal candidiasis in AIDS patients.
Laing RB. Brettle RP. Leen CL.
Regional Infectious Disease Unit, City Hospital, Edinburgh, UK.
A retrospective review of AIDS-related oesophageal candidiasis was undertaken to identify clinical features helpful in predicting response to azole therapy and patient survival. Patients who had received daily azole prophylaxis against candidiasis were significantly less likely to respond to azole therapy than those who had not (P < 0.001). Patients who had lost > 5% of their body weight in the 2 months before oesophageal candidiasis were less likely to respond to azoles than the others (P < 0.001). Amongst those who had not received daily azoles, patients with a CD4+ cell count < 25/mm3 were less likely to respond to azole treatment (P = 0.05). The median survival beyond oesophageal candidiasis was 18 months. Survival from oesophageal candidiasis was significantly poorer for patients who did not respond to azole therapy but AIDS survival did not differ between azole responders and non-responders. Non-responders who had been taking daily azole prophylaxis had the poorest survival (median = 4 months).
Seroprevalence of four sexually transmitted diseases in a semi-urban population of Gabon.
Bertherat E. Georges-Courbot MC. Nabias R. Georges AJ. Renaut A.
Service des Grandes Endemies, Franceville, Gabon.
Using the cluster-sampling method, the authors estimated the seroprevalence of 4 sexually transmitted diseases (STDs) among the sexually active general population in a city of 30,000 inhabitants in the east of Gabon. The seroprevalences were 2% for HIV-1, 13.8% for hepatitis B, 8.6% for Treponema pallidum and 59.6% for Chlamydia trachomatis. The seroprevalences of hepatitis B and chlamydia were stable over time and similar to those registered in other countries of central Africa. On the other hand, the seroprevalence of T. pallidum is notably low in comparison with these countries and seems to be decreasing. The seroprevalence of HIV-1 is also low but has doubled in 8 years in the city. Immigrant women from west Africa were a high-risk group for STDs but more generally, cohabiting was a risk factor for women.
HIV, hepatitis B and sexual practices in the street-recruited injecting drug users of Calcutta: risk perception versus observed risks.
Panda S. Chatterjee A. Bhattacharjee S. Ray B. Saha MK. Bhattacharya SK.
National Institute of Cholera and Enteric Diseases, Calcutta, India.
Injecting drug users (IDUs) were recruited from the streets of Calcutta to obtain a baseline biological and behavioural data on risk practices. One-fifth of them (mostly using buprenorphine) tested positive for hepatitis B surface antigen (HBsAg); 4% were reactive to serologic test for syphilis (VDRL: Venereal Disease Research Laboratory). Condom use was insignificant while 74% reported sex with female sex workers and 15% of male IDUs also reported having sex with men. Although, sharing of injecting equipment ('works') was perceived as dangerous by the IDUs, majority of them (90/103) reportedly shared it; cleaning of works before sharing was a concern for intravenous but not for intramuscular drug injecting. Half of the IDUs reported suffering ever from abscess; a proportion (12%) of which had had superadded attack of maggots in it. They were also found to be infected with HIV (1%, 95% CI 0.028-5.97%) at a low prevalence that prompted subsequent launching of needle syringe exchange programme, establishment of cleaning norms before sharing of works, cleaning of injecting site on the body and condom promotion.
High occurrence of HBV among STD clinic attenders in Bombay, India.
Kura MM. Hira S. Kohli M. Dalal PJ. Ramnani VK. Jagtap MR.
Department of Skin/STD and Microbiology, Sir J J Group of Hospitals, Bombay, India.
The pattern of sexually transmitted disease (STD) is the basis for designing surveillance of specific STD, their trends and syndromic management protocols. Two hundred and fifteen consecutive first-time STD clinic attenders at a teaching hospital in Bombay were recruited for the study in October 1995. Thorough clinical examination and the following investigations were done: wet mount, Gram stain, Giemsa stain, modified Thayer-Martin (MTM) medium culture, Fontana stain, Venereal Disease Research Laboratory (VDRL), Treponema pallidium haemagglutination test (TPHA), HBsAg and HIV. Ulcerative STD constituted 73.5% of total STD while 15.8% were discharges and 10.2% were genital growths. Ulcers in decreasing order of frequency were chancroid (51.9%), genital herpes (29.1%) and syphilis (14.5). 76.5% of genital discharges were due to gonococcal infection. The high rate of ulcerative STD is possibly an important co-factor for the high HIV prevalence of 31.2% in Bombay. Of 182 patients tested for HBV, 16 (8.8%) were reactive for HBsAg, revealing a high prevalence among STD attenders. A high co-relation of HBsAg positive with either HIV or VDRL requires urgent attention for HBV intervention strategies in this population.